How to adapt to the ever-evolving HIE landscape
While health information exchange (HIE) isn’t a new concept, it is a changing concept. Healthcare strategists need to stay on top of the changing technological and regulatory environment that consistently evolves the HIE space.
Michael Matthews, CEO of MedVirginia, told Healthcare Dive he believes HIE reinvents itself every 2.5 years. As new security and privacy considerations rise alongside technological advancements, HIEs need to be able to stay on target and advance initiatives that fit into a physician’s workflow.
”I like to say status quo is the competition and workflow is the enemy,” he said. Thus, staying on top of technology and regulations is paramount to HIE efforts.
By the end of the calendar year, Matthews said MedVirginia will have about two-thirds of all hospital records from the Commonwealth of Virginia accessible through its HIE. However, with more physicians making data available, a breadth of data is exceptional -- but if providers don’t dive deep into the crevasse, there is little value to the HIE push.
MedVirginia formed in 2000 and in 2010 became the first community-based HIE to connect to the Virtual Lifetime Electronic Record (VLER), a collaboration between the VA, DOD and civilian systems that connects health records of active-duty military personnel and veterans. Since beginning the HIE efforts, the system has had to adapt. One addition in the last five years was implementing a pre-fetch record service where physicians don’t have to leave the EMR to continue working on a continuity-of-care document (CCD). In addition, a clinical encounter alerts service has been added to their portfolio. “If you stay stagnant with technology…you’re roadkill,” said Matthews.
John Kansky, CEO and president of the Indiana Health Information Exchange (IHIE), didn’t expect his organization would employ someone with the job title Product Manager but here, in 2015, the exchange has one. With 14 million patient records flowing in the digital databank, more than the entire population of the state of Indiana, Kansky echoes HIEs need to evolve to ensure providers are using the data.
“[HIE] agencies have to run like a business,” Kansky told Healthcare Dive. There has to be a focus on producing value to the customer, he said.
Early services IHIE offered include Docs4Docs, an internal clinical results delivery service, and Quality Health First, a quality improvement application that manages clinical and administrative data from payors. A clinical data repository service which provides an aggregated view of the patient’s data to the provider, and automating public health transactions between the provider and public health systems are some examples of services built out in the recent past.
Last month, 17 million delivery transactions occurred within the HIE, a new high for the Indiana exchange.
Providing data at the point of care is key for value, thus sustaining the organization, Kansky said. “The good news is what took five to 10 years to build out doesn’t take nearly as long today.”
Mari Greenberger, MPPA, director of informatics at Healthcare Information & Management Systems Society told Healthcare Dive, “Many mature HIOs, while they may not have broken even from a financial stand-point have developed and implemented strong technical, business and sustainability plans to ensure they will be relevant over the years to come. ‘HIE 2.0’ need to be able to support and facilitate accountable care organization/value-based care models as they move into the next phase of HIO evolution.”
Such actions include leveraging existing infrastructure, community partners/stakeholders and ultimately getting the patients and providers more engaged with their care and treatment plans.
“[HIEs] will need to create data-driven understanding for their patients/community and do actionable analytics,” Greenberger said.
In the longer term, Greenberger notes HIEs will be a part of, if not all, use cases the federal government focus on in the coming years. “As the country moves from the fee-for-service payment models to more episode of care/Value-based care, models like the patient-centered medical home (PCMH) will become more critical because the information will need to follow the patient rather than the healthcare professional,” she said.
She suggested a realignment for reimbursement/payment with the quality of care provided – with the additional goal of driving costs down because healthcare providers are communicating better about a patient’s care/treatment plan.
“Public HIOs can definitely provide the vehicle, as a public utility for the region/state/community, to help facilitate the movement of fluid data where and when it is needed,” she said.
And the industry needs to remember who this activity should be benefiting…the patient. Matthews noted that sometimes “we get wrapped up in the bits and bytes” and need to remember the patient. “HIEs create digital feedback loops with information that can drive meaningful impact and actionable outcomes for all patients,” echoed Greenberger.
Follow Jeff Byers on Twitter